The Sound of Healing: How Doctors Are Using Sonic Waves to Treat Hardened Arteries

Intravascular lithotripsy, or IVL, is a newer medical technology that's quickly become an important tool for many heart and vascular specialists. By delivering gentle sonic pressure waves—similar to those used to break up kidney stones—IVL safely cracks hardened calcium inside arteries, allowing doctors to restore blood flow and place stents in vessels that are too rigid for traditional treatments.

For many physicians, including myself, IVL offers a safer and more predictable way to treat one of the biggest challenges in cardiovascular care: arteries that have become so calcified that they no longer respond to conventional tools, including stents.

That said, how and when IVL is used can vary widely. Some doctors reach for it right away in difficult cases to improve the chances of success. Others reserve it for specific situations—for example, when other approaches have failed or when open surgery would be too invasive.

Whether it's the go-to strategy or a tool for select patients, IVL's flexibility is part of what makes it so valuable. Many specialists now see it as a pivotal advance that's transforming daily practice in the cath lab and beyond.

According to Dr. Stéphane Manzo-Silberman, an interventional cardiologist in Paris, success with IVL starts well before the device reaches the artery. "The first step is to know where the calcium is," she explains. "Imaging helps you plan your approach and anticipate challenges." That preparation—combining angiography, imaging, and practical testing—sets the stage for more effective treatment.

Professor Marianne Brodmann, a vascular medicine expert in Austria, agrees. She describes IVL as "a tool that lets you match the treatment to the anatomy," emphasizing that understanding the severity and location of calcium helps physicians choose the safest, most efficient strategy.

From Backup Option to First Choice

For some doctors, IVL has evolved from a backup plan into a first-line therapy. Traditional practice often meant trying standard balloons or other techniques first, then turning to IVL only after those failed. But many physicians are now using it earlier, believing it leads to more consistent results and fewer complications.

At the Cleveland Clinic, Dr. Lee Kirksey, Vice Chair of Vascular Surgery, describes IVL as "a generational therapy—a treatment that is truly changing the field." By tackling calcium at the start rather than the end of a procedure, he says, operators can achieve better vessel expansion and more durable outcomes.

That shift is echoed by clinicians across different specialties. Dr. Uei Pua, Head of Interventional Radiology at Tan Tock Seng Hospital in Singapore, treats patients with critical limb-threatening ischemia, where restoring blood flow to the legs and feet can determine whether a patient heals—or faces amputation.

"Crossing blockages has become less of a challenge with modern techniques," Dr. Pua says, "but calcium still creates a daily double whammy that limits vessel expansion and reduces the effectiveness of drug delivery."

For him, IVL has been transformative: "It allows me to deliver controlled energy through a simple, low-risk platform to safely fracture calcium and achieve better lumen expansion—which means more blood flow to the foot and hopefully fewer repeat procedures."

Other specialists echo his experience, noting that IVL's predictability allows them to simplify their toolkits. Rather than switching between multiple devices, they can achieve consistent results with fewer steps. The approach shortens procedure times, reduces risk, and may lessen the need for open surgeries in complex vascular disease.

Opening New Possibilities

The same sonic technology is now expanding into new frontiers—including structural heart interventions that once required open surgery.

Dr. Sameer Gafoor, Medical Director of Structural Heart Disease at Swedish Medical Center in Seattle, has seen how IVL is broadening access to minimally invasive procedures like transcatheter aortic valve replacement (TAVR).

"The story of intravascular lithotripsy is very exciting," he says. "This field has grown from coronary and peripheral spaces to becoming a compelling option in the structural heart space."

In these procedures, calcium around the arteries can make it difficult to insert large catheters through the leg. IVL helps by gently cracking the calcium so that the catheters can pass safely—meaning more patients can undergo valve replacement without open-heart surgery. "IVL has revolutionized the field by enabling a predictable and safe approach," Dr. Gafoor explains. "Many patients who previously required alternative access can now be treated percutaneously."

This evolution represents a broader trend: technologies once used only for the most complex cases are now making advanced treatments available to far more people. Each incremental improvement—better vessel preparation, fewer complications, faster recovery—adds up to meaningful gains for patients who might otherwise have limited options.

What's Next for IVL

As with any fast-advancing field, there's still room to grow. The next generation of IVL systems aims to reach smaller, more delicate arteries and deliver energy more precisely to stubborn calcium. Researchers are also working to quantify how these sonic pulses translate into long-term benefits such as improved blood flow, reduced reintervention rates, and better quality of life.

FastWave Medical and other innovators are developing platforms designed to meet those needs. Ongoing clinical studies are expected to provide clearer evidence on how IVL compares with current standards of care—and how widely it might be used in the years ahead.

For now, IVL's rise reflects a broader truth in cardiovascular medicine: that innovation often comes not from doing more, but from doing it smarter. By using the physics of sound to solve one of the toughest challenges in vascular care, IVL is helping physicians restore blood flow safely, predictably, and with growing confidence.

And as those advances continue, the ultimate question may not be who needs IVL treatment—but rather, who wouldn't benefit from it?

Dr. Steven Kum is a consultant vascular surgeon at Mount Elizabeth Novena Hospital and a visiting consultant at Changi General Hospital, Singapore. He specializes in complex endovascular interventions, diabetic limb salvage, and wound care, and regularly proctors physicians across Europe and Asia. Steven is also the Chief Medical Officer of M&L Healthcare Investments, providing expertise on medical-related matters for potential investments.